-The group agreed on sets of uniform sampling criteria, placental gross descriptors, pathologic terminologies, and diagnostic criteria. The terminology and microscopic descriptions for maternal vascular malperfusion, fetal vascular malperfusion, delayed villous maturation, patterns of ascending intrauterine infection, and villitis of unknown etiology were agreed upon. Topics requiring further discussion were highlighted. Ongoing developments in our understanding of the pathology of the placenta, scientific bases of the maternofetoplacental triad, and evolution of the clinical significance of defined lesions may necessitate further refinements of these consensus guidelines. The proposed structure will assist in international comparability of clinicopathologic and scientific studies and assist in refining the significance of lesions associated with adverse pregnancy and later health outcomes.

+A: AbstractObjectives There have been many attempts to classify cause of death in stillbirth, all such systems being subjective, allowing for significant observer bias, making accurate comparisons between systems challenging. The aim of this study was to examine factors relating to determination of cause of death by using a large dataset from two specialist centres, in which observer bias has been reduced by objectively classifying findings and assigning causes of death based on predetermined criteria.Methods Detailed autopsy reports from intrauterine fetal deaths (IUFD) during [2005][2006][2007][2008][2009][2010][2011][2012][2013] in the second and third trimesters were reviewed and findings entered into a specially designed database, in which cause of death (CoD) was assigned using predefined objective criteria. Data regarding CoD categories and factors affecting determination of CoD were analysed through queries and statistical tests run using Microsoft Access, Excel, Graph Pad Prism and StatsDirect, with Mann-Whitney U-test and comparison of proportions testing as appropriate.Results There were 1,064 IUFDs, including 639 stillbirths at >23 weeks' gestation.Overall, around 40% (412 (39%)), had a definite or highly likely cause of death identified, whilst 60% (652) were classified as 'unexplained'. Of these, around half had identified risk factors, or lesions of uncertain significance present, whilst the remaining half (292 (45%)) were entirely unexplained. A stepwise increase in the proportion of unexplained deaths was observed with increasing severity of maceration. Black and Asian women had significantly greater proportions of deaths due to ascending infection whilst women aged over 40 had significantly increased placental-related causes of death. There was no significant difference in cause of death distribution by maternal 3 body mass index or with increasing post-mortem interval. Almost 20% of definitive or likely causes of death could be identified from clinical review or external examination / imaging of the fetus, with most of the remainder being determined following placental examination.Conclusions Based on objective criteria, most IUFDs across gestation remain unexplained despite autopsy examination. The rate of unexplained death varies between 30 and 60% depending on interpretation of the significance of features. The cause of death provided across studies is variable and dependent on both the classification system used and subjective interpretation such that reduction in the proportion of 'unexplained' cases across studies is largely based on speculation around mechanism of death. Novel methods to determine objectively the mechanism of death at postmortem examination are required. 4 +A: IntroductionThe primary aim of postmortem investigation of intrauterine death is determination of cause and mechanism of death, to facilitate counseling of parents, management of subsequent pregnancies and future interventions [1][2][3][4] . Over the last 50 years there have been many attempts to classify cause o...

Objective

Objectives Of 780 000 births annually in the UK, around 3300 are stillborn, a rate of approximately 4 per 1000 births. Traditional epidemiological associations are based on historic data. The aim of this study was to document contemporary demographic findings in a large series of > 1000 deaths in utero in London and compare these with national datasets. Methods From a dedicated database, including > 400 data fields per case, of fetal, infant and pediatric autopsies performed at Great Ormond Street Hospital and St George's Hospital, London, we extracted information on all intrauterine deaths, excluding terminations of pregnancy, from 2005 to 2013, inclusive. Demographic data were analyzed according to the gestational age at which fetal death occurred (second‐trimester intrauterine fetal death (IUFD), subdivided into early (< 20 weeks) and late (20–23 weeks) IUFD, and third‐trimester stillbirth (≥ 24 weeks)) and compared with national datasets when available, using Mann–Whitney U‐test and comparison of proportions testing as appropriate. Results Data were available from 1064 individual postmortem reports examining intrauterine deaths delivered between 12 and 43 weeks' gestation, including 425 IUFDs (246 early and 179 late) and 639 stillbirths. Compared with the overall UK pregnant population, women in whom an intrauterine death occurred were significantly older and more obese. White mothers had a higher proportion of stillbirths (as opposed to IUFDs) than did non‐white mothers, whereas black mothers had a higher proportion of IUFDs relative to stillbirths. Increased body mass index was associated with increased risk across all groups. Women who had uterine fibroids, those who had a history of vaginal bleeding in early pregnancy and those who had undergone assisted conception had a relatively higher proportion of IUFDs than stillbirths. Conclusions Based on a large series of >1000 autopsies in cases of intrauterine death, these data highlight the increased risk for fetal loss associated with maternal demographic factors in contemporary clinical practice, particularly associations with increased maternal age and body mass index. Among women in whom an intrauterine death occurs, maternal ethnicity, mode of conception and gynecological history are associated with differing timing of fetal loss. Further research is required to understand the mechanisms involved in such maternal factors in order to develop preventative strategies. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Increasing hours of NHS obstetric consultant presence may increase chance of non-instrumental vaginal delivery.